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Med Students Unaware of Their Bias Against Obese Patients
An anonymous reader sends news of a study which found that "two out of five medical students have an unconscious bias against obese people." The study, published in the Journal of Academic Medicine (abstract) examined med students from many different cultural and geographical backgrounds.
"The researchers used a computer program called the Weight Implicit Association Test (IAT) to measures students’ unconscious preferences for 'fat' or 'thin' individuals. Students also answered a survey assessing their conscious weight-related preferences. The authors determined if the students were aware of their bias by seeing if their IAT results matched their stated preferences. Overall, 39 percent of medical students had a moderate to strong unconscious anti-fat bias as compared to 17 percent who had a moderate to strong anti-thin bias. Less than 25 percent of students were aware of their biases. 'Because anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity, teaching medical students to recognize and mitigate this bias is crucial to improving the care for the two-thirds of American adults who are now overweight or obese,' Miller said. 'Medical schools should address weight bias as part of a comprehensive obesity curriculum.'"
I'm not unaware. I know exactly what I think about fat people and It's not good.
Compassion is supposed to be a hallmark trait of the medical profession. Any doctor who lets his personal beliefs get in the way of his practicing medicine in the best possible way to ANY patient - be s/he fat, thin, muslim, atheist, black, green, prisoner, retarded, or just an average joe - is a bad doctor. If a patient is obese then yes, it poses a serious health risk and a problem. My job as a doctor is not to lecture that patient or make fun of them, but to try to help them as much as I can with the tools I have at my disposal. The same for alcoholics, drug addicts, and anyone else. Because at the end of the day said behavior is usually just a symptom of a different, underlying problem.
Seven puppies were harmed during the making of this post.
For those not familiar with implicit association tests, they are based on measuring your reaction times when matching certain types of data according to different specified criteria. For example a gender association test might measure time for matching gender with staying at home raising children versus working outside the home.
Harvard has plenty of sample tests.
Having taken some of the tests I can say that the results can be quite surprising and point out biases that you are unaware of. I definitely found that some associations were much easier for me than others. (Happy to say that the gender example above was not a problem for me.)
"anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity"
Being fat-positive would help with the treatment of obesity?
"Doctors are more likely to assume that obese individuals won’t follow treatment plans"
The primary goal of our treatment plan is often to get them to lose weight to cure their hypertension and type 2 diabetes. It's not a bias if you see the same patient in clinic every few months for years and they continue to gain weight and ignore your recommendations.
**** ********* M.D. , PGY-4 Resident
were obese? When my wife was in med school about half the class was obese, a few morbidly so.
Are you unaware that "Less than 25 percent of students were aware of their biases" means that 75% were unaware of their biases?
Sounds as though that is a pretty apt title.
Sure, it is biases against "various weights" not just "overweight & obese", but the point still stands.
Thirty four characters live here.
A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices.
No shit. That is not what they mean by bias in this study. RTFA:
“Bias can affect clinical care and the doctor-patient relationship, and even a patient’s willingness or desire to go see their physician, so it is crucial that we try to deal with any bias during medical school,” said David Miller, M.D., associate professor of internal medicine at Wake Forest Baptist and lead author of the study.
“Previous research has shown that on average, physicians have a strong anti-fat bias similar to that of the general population. Doctors are more likely to assume that obese individuals won’t follow treatment plans, and they are less likely to respect obese patients than average weight patients,” Miller said.
Well, you completely missed the point. Doctors who don't recognize their biases are more likely to misdiagnose patients that they're biased against.
Take me, for example. My kidneys failed due to IGA nephropathy, which has absolutely nothing to do with weight. I'm overweight, however, so for the first year of me feeling run down, getting sick often and having other health isuses my doctor insisted that I just needed to lose weight. He never bothered looking for other potential causes because, in his mind, the problem had to be that I was too fat and therefore didn't deserve any further attention.
I explained it in simple terms and offered a real life example and you still can't figure out why a doctor that doesn't recognize his biases is a bad thing?
Second, and by far most intriguing, is the 33% (101/310) of students who openly acknowledged an explicit personal bias. Given that 39% (121/301) were found to have an actual bias on the implicit test, on the surface this result isn't surprising - but the 101 who think they're biased, and the 121 who actually have an implicit bias, don't overlap very closely. Just 40 students who thought they had a bias actually did. The study authors (and the journalists who have summarized their results) decided to frame this in the form of two-thirds of anti-fat students don't know they're biased! It's much more curious, I think, to note that a healthy majority of students who thought they were biased against the obese - 61% (61/101) - actually aren't.
Indeed, it turns out that there wasn't a significant correlation between believing one was biased and actually having a bias. So why do three out of five students who think they have an anti-fat bias hold that belief mistakenly?
~Idarubicin
It's slightly complicated by all the bad advice that's given on how to manage ones weight.
However, when all is said and done, eating less and moving more solves the problem for most people. Sometimes there's a need to fix ones sleep and or stress in order to lose the weight.
But, doctors themselves are a terrible source of information on diet and exercise. Unless it's changed recently, they only get a few weeks of training on diet and none on exercise.
Citation: http://daveatherton.wordpress.com/2012/03/17/the-true-costs-of-treating-smokers-the-obese-and-the-healthy/
It is just a summary but they link to their more official sources. The core values, as quoted from the blog: The lifetime costs were in Euros: Healthy: 281,000 Obese: 250,000 Smokers: 220,000
So, obesity saves more than 10% of lifetime healthcare cost.
Thank you! I knew that was true of smokers, but wasn't sure about obesity. Despite silly things like objective data (which Slashdotters otherwise rightly insist on) people will still use "fat people raise my healthcare costs" as an excuse for their sanctimony.
I'm not quite obese but I am overweight, and it's because I suffer from two conditions (CFS and arthritis) that making losing weight extremely difficult. It isn't a lifestyle choice, and before these two things got bad I was able to stay fairly trim.
I feel bad. I don't like the way I look. Thing is though, it really isn't my fault. I wish it was because then I could do something about it.
Don't make assumptions about people you don't know.
const int one = 65536; (Silvermoon, Texture.cs)
SJW, n: "Someone I don't like, and by the way I'm a fuckwit" - AC
Let me ponder this for a minute.
A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices. Being fat indicates that a person has made one HELL of a lot of unhealthy choices. Like - every single day, he eats to much.
Alternately they have hypothyroidism, for example, as a result of Hashimotos. It could also be Prader-Willi syndrome, or Bardet-Biedl syndrome. There are other genetic factors and diseases which can also result in obesity. Candida Albicans infections of the gut have also been implicated. There are also medications which can result in obesity. Prednisone, which is often used to treat very severe allergies, and also as an anti-rejection drug following organ transplantation, or to treat autoimmune disorders, is one. Others include antidepressants, seizure medications, and certain high blood pressure drugs, such as atenolol and metoprolol (both beta blockers).
I must be one of the lucky few people in the U.S. then. I have two doctors who actually cared enough to get to know me as a person and realize why I have the problems that I have. One of those doctors is my E.N.T. He spent a lot of time and energy clearing up a chronic ear infection and has helped me with some other issues related to my health. The other "doctor" is a nurse practitioner who performed a yearly physical and found that I had a HORRIBLY under-active thyroid that lead to me gaining 30 pounds in just over 4 months. I have spent most of the past year on medication, adjusting the dosage to be correct for my needs. I figure between that and my joining a crossfit gym (if you need to know what it is use some Google fu) I will be loosing most of the weight I have gained. I had a coworker state that I am "unhealthy" because of my weight, yet this same person eats Chinese take out crap 6 days a week, and the other day he eats McDonald/taco bell/fast food and sees nothing wrong with this. He also thinks because he is thin he is in good shape. I have also seen some people who are rail thin, but have an astonishing high problem with diabetes, arthritis, high body fat percentage, and other issues. Yet the doctors tend to take one look at them and say oh you are perfect because you fit the model of health we are taught by the school/government. I have a friend who is overweight, and she knows it. She realizes she has a problem and is working on fixing it with medication, diet, exercise, and a support group. She has a medical condition that was found by a doctor, AFTER she demanded the appropriate tests. Her nutritionist and doctor spent a lot of time going round and round with the results from the test, the doctor did not believe it and thought that diet/exercise was the only reason for the problem. The nutritionist realized that it was a metabolism issue and that it would take some medication in addition to the normal move more, eat less regimen. She physically could not get appropriate nutrition from food, and that lead to eating more to get the required nutrition. This cycle lead to a bunch of other issues, the least of which being weight gain. The medical industry in the U.S. is BROKEN and requires a complete reboot. I have a friend who went to college and graduated with two undergrad degrees and had NO debt. This friend then went to medical school and racked up over three hundred thousand dollars in debt due to tuition, fees and expenses. This is after fighting to get a slot in med. school due to the AMA setting up a limit to how many slots can be made in a given year. He will now be spending the REST OF HIS LIFE paying off student loans from medical school. This same "education" taught outdated skills and minimized critical thinking outside of the industry standards. Thankfully he had an amazing bit of training from his grandparents who were doctors in another country, and knows how to fix things without resorting to over-used, over-priced medications. And he knows what it means to be unconsciously biased against as he is an openly gay man.
*Are* they less likely to follow treatment plans? It stands to reason that someone who won't do what's necessary for his health in one area might be less likely to do so in another area as well.
Studies have shown that the most common assumption is that fat people are lazy, undisciplined, unwilling to work hard, etc. -- not just in terms of health choices. Your comment is playing directly into that bias.
I think this bias, like most, actually does have some relationship to reality -- i.e., a greater percentage of fat people are likely to have these traits than others.
HOWEVER -- pre-judging an individual on the basis of a single characteristic is the very definition of "bias."
Even if 90% of obese people are lazy bastards who won't even try to listen to their doctor's advice (and I don't think the number is that high), that does not excuse a doctor who provides inferior treatment to the other 10% because of assumptions.
If the doctors' assumption is accurate, it's not bias in the sense implied.
That's like saying -- If a black person is driving around a rich neighborhood, he must be looking to steal something -- because "black people are more likely to commit crimes" is an "accurate" statistic.
Even if X is often correlated with Y, it doesn't justify the assumption that X always implies Y. When dealing with healthcare, these sorts of assumptions can literally be deadly, such as when a physician fails to search for secondary contributory causes of obesity in a particular patient because the assumption is just that the patient must be a lazy bastard who can't follow directions.
The problem here is that the only signal people have for what their body needs energy-wise is mediated by their hormone balance and brain-chemistry. If you have a condition where even too much energy feels like you're starving (a painful condition), it's readily understandable that you are going to eat too much, even with the best intentions. The problem of simply blaming "eating too much" is that it becomes synonymous with gluttony - a vice and failure of virtue. Even though yes, you are simply eating too much in the thermodynamic sense, it rapidly becomes a stigma where the patient is 'at fault', rather than the underlying medical condition. In this way, victimisation of obese patients is counter-productive.
Sure some people simply have no self-control - but is that because they are bad people, or because there is some factor at work that makes it hard for them? The blame game for obesity is a bit like accusing people with a birth mark of being in league with the devil and burning them - we should know better by now.
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I have CFS too so I know what you're going through, I've been overweight because of it as well, but I've recently found one thing that has allowed me to lose weight and actually become healthier. There is only one diet that has worked, and it's basically a variant of low carb, it's called Keto(ketosis) and I've lost 50 pounds in a year from it, and all I've done is changed my diet. I don't exercise more than I already do (sometimes not at all), I don't starve, and I don't have to go without eating or skip meals or anything, I would seriously suggest as a fellow CFSer to try it.
http://en.wikipedia.org/wiki/Ketogenic_diet
http://josepharcita.blogspot.com/2011/03/guide-to-ketosis.html
http://www.ncbi.nlm.nih.gov/pubmed/22905670
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/
There are objective tests. Doctors with a bias won't give them. I went and got hydro-statically weighed. I know that my lean body mass is 169 lbs. My height is 5'11" and at my last physical I was 212 lbs. That put my body fat percentage at 21%. This is at the high end of "ideal". On the other hand, the BMI put me at the high end of "over weight" and only 3 lbs shy of "obese". According to the BMI I should not weigh more than 178 lbs. That would be 5% body fat. This is the point that you start eating into your essential body fat. So, according to the BMI my body fat should be between 5% and -30% body fat. That is right. The BMI says I should be between sick and dead.
At this physical, my doctor is telling me that I need to lose weight because 212 is "a lot of weight". He didn't car that my body fat % was fine. He just kept pointing out that BMI is "the best indicator of healthy weight". He has a bias against fat people. Even worse, his definition of "fat" is completely twisted and dangerous.
Even worse is that I have been 5 lbs over weight. 5 lbs overweight isn't even close to obese. It also isn't "some buff slav". But, what I hear is from dumbasses saying "Your not Mr. Universe, so the BMI is correct."
True story to back this up -- I was 140 lbs at 6'5 in highschool with very bad joints and asthma I sadly seem to have inherited. Both limit my exercise immensely, as does my job in computers.
Having subsequently moved and having a different doctor now than then and weighing substantially more, I have no new health problems than then but my new doctor upon hearing of my breathing and joint issues blamed my weight and told me to lose it, which obviously won't help, as I had the same problems when clinically under-weight.
Bias is wrong -- and leads to poor assumptions.
- Michael T. Babcock (Yes, I blog)
Doctors should diagnose based on full spectrum data collection. Not simply based on what they see and think at first glance.
I had this discussion a dozen times with my brother who is a medical student and the tl;dr is "nobody has the time or money for that".
A doctor will always assume the most likely cause for any given combination of symptoms (even if they don't match 100%) and only start thinking about less likely alternatives if his treatment doesn't lead to improvements. Yes, sucks to be someone with a rare disease (that will only be diagnosed correctly very late if at all) but symptoms are often so unspecific and a thorough examination would be so expensive (let's do a blood screen every time you catch a cold because you might have some ultra-rare disease?) that this is the only practicable way.
Hormonal causes for obesity are possible but pretty rare - a much larger share of obese patients claims to suffer from e.g. thyroid issues than statistically possible. "Just eat less" is the right answer for the vast majority of obese patients and as they will lie to you about their food intake and exercise (admittedly often unconsciously, but then they don't tend to cooperate well when you ask them to keep a diary of every single thing they eat to make the more self-conscious) you never know if your original attempt at treatment did work or not. The share of patients who will lie into your face about having tried everything is probably still much larger than the share of patients who have actually followed your advice and it didn't help because they have some underlying physical issue.
The standard medical procedure of most likely diagnosis -> treatment -> in-depth examination if treatment doesn't show results just breaks down as the doctor has no way of knowing whether the treatment ever took place or not.